Midwifery in the Time of COVID-19, an Exploratory Study from the Perspective of Community Midwives

Abstract

Significance: The decision of where to give birth is an important decision an expectant person must make. Possibly driven by rising maternal mortality rates, an increasing minority of people in the United States are choosing to give birth at home or in a freestanding birth center. There is anecdotal evidence that interest in community birth further increased during the COVID-19 pandemic and that COVID-19 likely impacted community birth in other ways as well. Purpose: The purpose of this study was to explore how community-based midwives in the greater Seattle area were affected by the COVID-19 pandemic to understand the needs, barriers, and successes of community midwifery during COVID-19. Population Study participants included 11 community midwives (N=8 licensed midwives, N=2 midwifery students, and N=1 certified nurse-midwife) from the greater Seattle area actively practicing in Washington State during the COVID-19 pandemic. Methods: This was a qualitative study that used semi-structured interviews conducted online using the online platform Zoom video technology and were audio recorded (with participant consent) for accuracy. Interviews were transcribed verbatim from recordings. Analysis Transcripts were analyzed using deductive and inductive coding. Initial a priori codes were informed by an adapted version of the Provider Burnout Model. The codebook started with a select few deductive codes created by the PI, while the majority of codes were added to the codebook inductively during the data collection period. Two coders independently coded one data transcript, using a tentative codebook. The codebook was revised and definitions were clarified through a consensus meeting. Following this, all 11 interviews were each coded by the two coders (the PI and a second qualitative researcher), and coding was revised to ensure substantial inter-coder reliability for each transcript. Codes were then clustered to identify themes. Results: Primary themes included 1) practice changes related to COVID-19, 2) COVID-19 and increased demand for community midwifery, 3) COVID-19 and exacerbated disparities 4) relationships with hospitals and institutions and, 5) opportunities for the future of community midwifery. Conclusion: This study provided rich insight into the experiences of community midwives providing care during the COVID-19 pandemic. Being forgotten in the state's COVID-19 response; lack of access to vaccines and personal protective equipment; unfavorable interactions with other providers; additional uncompensated labor; exacerbated racial disparities; and lack of diversity in the current community midwifery workforce created challenges during this time. Support from other community midwives and the Midwives Association of Washington State (MAWS) and telehealth options helped to ensure community midwives could continue to serve their patients. These experiences can provide insight for future emergency planning to better protect the community midwifery workforce or other birth workers.